{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T17:58:15Z","timestamp":1777658295924,"version":"3.51.4"},"reference-count":18,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2013,9,25]],"date-time":"2013-09-25T00:00:00Z","timestamp":1380067200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Laparoscopic appendectomy is a common emergency pediatric surgery procedure accompanied by substantial pain (pain scores &gt;4 for &gt;60% of the time) in 33% of these patients. We introduced a bundle of pain management interventions including local anesthetic infiltration at the incision site, intravenous (<jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>) opioids by patient\u2010controlled analgesia (<jats:styled-content style=\"fixed-case\">PCA<\/jats:styled-content>), and scheduled doses of <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> ketorolac and oral acetaminophen\/hydrocodone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To evaluate the effect of these pain management interventions on pain control after laparoscopic appendectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively studied pain in 206 children above 7\u00a0years of age undergoing laparoscopic appendectomy from December 2011 to February 2012 at our institution.\u00a0We extracted data on patient demographics, duration of anesthesia and surgery, intraoperative opioids, local anesthetic infiltration, surgical procedure reports, along with pain scores, postoperative <jats:styled-content style=\"fixed-case\">PCA<\/jats:styled-content> use, and opioid\u2010related complications and hospital stays. Patients were divided into two groups \u2013 simple appendicitis without peritonitis and appendicitis with generalized peritonitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The incidence of substantial pain when the multimodal regimen was used was 12%, which is significantly lower than earlier reports (Fisher's exact test <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). Patients with generalized peritonitis experienced more pain, consumed more opioids, had more unmet <jats:styled-content style=\"fixed-case\">PCA<\/jats:styled-content> demands, and a higher incidence of respiratory depression compared with those with simple appendicitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The multimodal regimen of local anesthetic infiltration, opioid by <jats:styled-content style=\"fixed-case\">PCA<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> NSAID<\/jats:styled-content>s, and oral acetaminophen\/hydrocodone reduced the incidence of substantial pain. Additional studies are required to identify subgroups of patients with minimal opioid requirements who can benefit from modifications of this regimen.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.12271","type":"journal-article","created":{"date-parts":[[2013,10,11]],"date-time":"2013-10-11T21:56:07Z","timestamp":1381528567000},"page":"1187-1192","source":"Crossref","is-referenced-by-count":37,"title":["A retrospective study of multimodal analgesic treatment after laparoscopic appendectomy in children"],"prefix":"10.1111","volume":"23","author":[{"given":"Yang","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Pediatric Anesthesiology Texas Children's Hospital Baylor College of Medicine Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Seipel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Anesthesiology Texas Children's Hospital Baylor College of Medicine Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica E.","family":"Lopez","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery Texas Children's Hospital Baylor College of Medicine Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jed G.","family":"Nuchtern","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery Texas Children's Hospital Baylor College of Medicine Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary L.","family":"Brandt","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery Texas Children's Hospital Baylor College of Medicine Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara C.","family":"Fallon","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery Texas Children's Hospital Baylor College of Medicine Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter A.","family":"Manyang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Anesthesiology Texas Children's Hospital Baylor College of Medicine Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imelda M.","family":"Tjia","sequence":"additional","affiliation":[{"name":"Department of Pediatric Anesthesiology Texas Children's Hospital Baylor College of Medicine Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahul G.","family":"Baijal","sequence":"additional","affiliation":[{"name":"Department of Pediatric Anesthesiology Texas Children's Hospital Baylor College of Medicine Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehernoor F.","family":"Watcha","sequence":"additional","affiliation":[{"name":"Department of Pediatric Anesthesiology Texas Children's Hospital Baylor College of Medicine Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,9,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1055-8586(98)70035-6"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1089\/lap.2007.0070"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31828866b3"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2011.03711.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-197011000-00020"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0952-8180(94)00001-K"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2012.03.002"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(05)82169-9"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31828866e1"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2006.08.014"},{"key":"e_1_2_7_12_1","unstructured":"CohenMR WeberRJ MossJ.Patient\u2010Controlled Analgesia: Making It Safer for Patients. 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